Profiles

Become a Fan

October 06, 2014

The Fog & Lies Bedeviling Our Health Care

It is hard to believe that something as simple and as important as a flu shot can be so difficult for the world's most advanced medical system. Either authorizing a flu shot is something more complex than I think or just maybe our medical system or at least the delivery of preventive care is not all that it is cracked up to be.

I have seen it all in this year. I went from a standard Blue Cross package to an Affordable Health Care plan with Blue Cross to Medicare to a Medicare Advantage Plan with Blue Cross. All that happened in the space of four months.

With that background, my wife and I planned to get our 2014 flu shots from Walgreen's where we have gotten them the last couple of years.

We have not missed a flu shot in fourteen years. My very efficient wife had already gotten the forms and we filled them out at home. Because we are both over 65 and our younger daughter is about to have our second grandchild, we were told to get an extra strength flu shot and a TDAP shot.

Medicare Part B covers 100 percent of the cost of a flu shot once every flu season with no Part B deductible required. This is true for both Original Medicare and Medicare Advantage plans.Original Medicare will pay for the flu shot no matter where you get it, as long as the health care provider is enrolled in Medicare.

You will pay no copay or deductible if you see a doctor or other health care provider who takes assignment. If you receive your Medicare benefits from a Medicare Advantage plan, the plan cannot require that you get a referral for the vaccine, but it can require that you use providers in the plan’s network.

We called ahead to make sure Walgreen's had the flu vaccine we need and headed off to get our shot. My wife, who has not transitioned to Medicare from Blue Cross Affordable Care quite yet, had no trouble getting her shot.

It took an hour and fifteen minutes before I got my shots and I had to agree to pay for it myself. The extra strength flu shot and other shot that I got cost $118. I was assured by the Walgreen's technician that Blue Cross promised to reimburse me for my shots.

We got a pretty good song and dance from Walgreens. The net of it was that the only policy of mine that Blue Cross could see was the one that was terminated in February. I have a hard time buying that since I have been paying Blue Cross and their specified deductible for appointments with a doctor over the last few months.

Since we were only a quarter of a mile from our insurance agent, we thought we should stop by and see if they could explan why I could not get a flu shot without paying for it. An agent called Blue Cross for us and confirmed that Walgreen is listed as a provider. His only guess was the federal government is requiring all Medicare folks to use one flu shot provider.

That did not make much sense to me given what I had seen on the Medicare site but after nearly two hours I was tired of fighting and the agent was offering to mail in our claim for us so we took him up on that and went home with our heads shaking.

We wondered if the federal government is only paying for certain providers, why isn't there a giant billboard telling us whom that might be?

Obviously we are not getting the correct story. All I know for sure is that health care was a whole lot easier in Canada.

All I had to do was give them my number and we got whatever care we needed. As to lessons learned from this. One is that I will not be going back to Walgreen's for any shots. I probably would have walked out this time if we were not fighting a deadline so we could visit our next grandchild. Two is that we might be the most advanced country in the world capable of some medical miracles, but getting access to even basic services like a flu shot is not exactly simple. We have some great doctors and medical professionals, but I think they too deserve a better system.

As to my reimbursement, I am not holding my breath. We had an even more complex experience getting shingle shots. At the time we were getting ready to visit Canada and one health care professional told us it would be easier to find a clinic in Canada for the shingles shot. We persevered and got it in the United States, but it took untold hours and over two years to get that claim resolved.